强直性脊柱炎脊柱骨折的特点及诊断

目的：探讨强直性脊柱炎脊柱骨折的特点，为其临床诊断与治疗提供参考。方法：回顾性分析1994年1月～2001年10月收治的19例强直性脊柱炎脊柱骨折病例。结果：所有19例患者均符合强直性脊柱炎的诊断标准，其中17例骨折前有平均20．6年的强直性脊柱炎病史，另2例方确诊有强直性脊柱炎。19例中15例有外伤史，其中9例为平地跌倒或扭伤，另4例无外伤史。损伤机制：过伸伤7例，垂直挤压伤2例，侧屈损伤l例，屈曲伤1例，4例不详。颈椎骨折11例，9例发生在C5～C7；包括剪力骨折lO例，应力骨折1例。胸腰椎骨折8例，7例为应力骨折，均发生在T10～L2，1例为L3剪力骨折。19例中经椎间隙骨折12例，经椎体骨折7例。三柱骨折16例，骨折伴脱位5例。9例并发脊髓损伤，其中8例为颈椎骨折。外伤至诊断为骨折的间隔时间为10h～7个月，平均29．6d。2例曾被误诊为脊柱结核。结论：导致强直性脊柱炎患者发生脊柱骨折的外力往往较轻。损伤机制多为过伸伤。骨折好发于下颈椎及胸腰段。剪力骨折多发生在颈椎，大多为三柱骨折，容易伴发脱位，脊髓损伤的发生率较高；应力骨折多发生在胸腰段，脊髓损伤不多见。此类骨折多为经椎间隙骨折，易发生诊断延误。     

椎弓根固定治疗强直性脊柱炎合并胸腰椎骨折13例分析

目的分析强直性脊柱炎合并胸腰椎骨折的特点,探讨采用椎弓根内固定术治疗方法的有效性。方法 2006年1月～2011年1月在笔者所在医院采用椎弓根内固定术治疗强直性脊柱炎合并胸腰椎骨折的患者13例,回顾性分析其临床及随访资料。结果 13例患者术中手术均获成功。影像学检查表明所有患者均骨性愈合,复位良好,内固定物位置良好、无松动断裂现象,未见骨折内固定节段不稳征象。结论椎弓根内固定术是治疗强直性脊柱炎合并胸腰椎骨折的有效方法。     

强直性脊柱炎合并胸腰椎Chance骨折的手术选择

目的探讨单纯后路内固定治疗强直性脊柱炎(ankylosing spondylitis,AS)合并胸腰椎Chance骨折的临床疗效。方法收集本院2000年1月~2013年12月收治的获得完整随访资料的AS合并胸腰椎Chance骨折的患者182例,均行单纯后路椎弓根螺钉内固定术,固定每个伤椎上下各2个椎体,必要时行扩大内固定术。分析患者临床资料、随访资料及影像学资料。结果所有患者随访12~41个月。骨折愈合良好,内固定物无松动和断裂。术后患者脊髓功能恢复良好,Frankel分级均恢复至D级或E级。结论 AS合并胸腰椎Chance骨折经单纯后路复位椎弓根螺钉内固定,在伤椎上下各固定2个椎体,可获得坚固内固定,骨折愈合良好。     

强直性脊柱炎脊柱骨折的治疗

目的 了解强且性脊柱炎(AS)脊柱骨折治疗的特点及注意事项。方法对19例AS脊柱骨折病例进行回顾性分析硬随访,19例中颈椎骨折11例,9例发生在C5-7间;胸腰椎骨折8例,7例为应力骨折,均发生存T10-L2间。二柱骨折16例。9例并发脊髓损伤,其中8例为颈椎骨折。所有19例患者均接受了手术治疗。颈椎骨折或脱位采用了4种手术方式,其中9例做了前路间盘切除或椎体次全切除、椎间值骨加钢板内固定术。胸腰椎骨折也做了4种术式,其中5例的术式为后路长节段固定加前、后联合融合,结果术岳18例患者获得了平均46．4个月的随访。并发脊髓损伤的9例患者,术后8例的神经功能有恢复。18例患者的骨折部位均已骨性愈合一术中并发脊髓损伤2例,因脑血管意外死亡1例,并发肺炎2例。结论 AS脊柱骨折好发于下颈椎及胸腰段,大多为三柱骨折,颈椎骨折并发脊髓损伤的发生率较高。胸腰椎多为应力骨折一手术治疗可使大多数患者的骨折愈合良好,神经功能有不同程度的恢复。对颈椎骨折患者,可采用前路椎体问植骨、钢板内固定的术式;而对于胸腰椎骨折,主张后路长节段固定,前、后联合植骨融合,术中及术后均可能出现并发症,应注意预防或避免。     

强直性脊柱炎颈椎骨折影像学特点及手术方式选择

目的 探讨强直性脊柱炎(ankyiosing spendylitis AS)合并颈椎骨折的影像学特点和手术方式选择;方法对30例强直性脊柱炎颈椎骨折(ankylosing spondylitis cervical spine fractureASCSF)患者的影像学特点以及前路、后路和前后路联合三种不同手术方式的结果进行分析;结果强直性脊柱炎颈椎骨折多表现为三柱损伤,多合并相对较重的脊髓损伤,影像学特点根据骨折脱位的不同表现不同,骨折多位于椎间隙部位,部分无明显脱位的患者X线和CT检查易漏诊,MRI检查阳性率较高,治疗上首选外科手术稳定融合和脊髓减压,手术方式可根据骨折脱位情况和脊柱强直情况不同选择不同的稳定方式.结论 强直性脊柱炎颈椎骨折一种相对严重的损伤,影像学根据损伤不同表现不同,治疗上以手术稳定脊柱和脊髓减压为主,前路、后路和前后路联合稳定脊柱是主要方式.     

强直性脊柱炎胸腰椎骨折的损伤特点和治疗

目的分析强直性脊柱炎胸腰椎骨折的损伤特点,探讨治疗方法。方法强直性脊柱炎胸腰椎骨折11例,保守治疗1例(L1压缩性骨折者);手术治疗10例,其中前路手术减压内固定3例,后路椎弓根螺钉系统复位内固定、植骨7例。结果切口无感染,无脑脊液漏。1例T12L1骨折行后路椎弓根螺钉系统复位内固定并植骨术(未行椎管探查或减压),麻醉苏醒后发现脊髓神经症状由术前的C级加重为B级;1例L3～5骨折伴马尾神经损伤行前路手术后第2天出现内固定松动、骨折椎再次移位,脊髓神经症状加重,再次行前路内固定取出和后路长节段椎弓根螺钉系统固定植骨术。患者均获得随访,时间10个月～5年,平均(32±4.8)个月,手术患者中8例植骨于6个月获得融合,2例不能明确是否融合。后期未出现内固定松动或断裂现象。脊髓神经损伤者除1例A级无改变、1例C级加重为B级(末次随访时为C级)、1例D级加重为A级外,其余3例有Ⅰ～Ⅱ级的恢复。9例无腰背痛,2例遗留轻度腰背部酸痛。结论强直性脊柱炎胸腰椎骨折患者宜行后路椎弓根螺钉固定、植骨治疗。     

强直性脊柱炎合并骨折的特点及手术治疗研究进展

<正>强直性脊柱炎(AS)是一种累及人体中轴骨的慢性炎症性疾病,常由于骶髂关节炎、肌腱炎、脊柱附着点炎症及韧带骨化等原因导致背部疼痛~([1]),常伴有严重的骨质疏松,早期即可发现~([2]),晚期伴有严重的后凸畸形,常表现为颈椎、腰椎前凸减小甚至变为后凸及胸腰段后凸~([3])。AS患者多存在脊柱骨性强直、椎体骨质疏松及脆性增加,因此,无外力或轻微的外力作用即可发生脊柱骨折,且容易并发严重的脊髓损伤~([4]);病史较长的患者,常形成僵     

强直性脊柱炎脊柱骨折的延误诊断

[目的]分析强直性脊柱炎(ankylosing spondylitis,AS)患者脊柱骨折延误诊断的原因.[方法]总结2008-2019年本院收治的强直性脊柱炎脊柱骨折延误诊断的患者,分析骨折特点及延误诊断原因.[结果] 2008-2019年,本科收治脊柱疾患患者共63573例,其中最终确诊脊柱骨折3363例,占5.2...     

强直性脊柱炎颈椎骨折的治疗

目的：探讨强直性脊柱炎（AS）患者颈椎骨折的治疗方法及效果。方法：回顾分析1990年1月～2003年12月收治的20例AS合并颈椎骨折患者，7例采用非手术治疗，1例采用前路AO钢板内固定，5例采用前后路联合固定，2例行后路侧块螺钉内固定，5例采用颈椎椎弓根螺钉固定。手术组术前Frankel分级A级3例．B级5例，C级3例，D级1例，E级1例；非手术组术前Frankel分级A级2例，B级2例，C级1例，E级2例。结果：非手术组中5例有神经症状者3例死亡．2例无恢复；平均4．8个月获得骨性融合。手术组中1例行前路手术者，术后第3天钢板脱出，改行前后路联合内固定融合；5例前后路联合内固定患者中，1例术中牵拉致喉返神经损伤，术后3个月自行恢复，1例死亡，其余患者术后平均3．4个月骨性融合。2例后路侧块螺钉同定者术后平均4．1个月骨性融合。5例行颈椎弓根螺钉固定者术后平均3．6个月骨性融合。手术组12例有神经症状者中1例死亡，9例有不同程度的改善。结论：AS伴颈椎骨折采用非手术治疗术后神经损伤症状无明显改善，且存在复位困难、外固定不牢、易出现肺部感染等并发症。手术治疗可稳定脊柱、解除压迫及早期康复锻炼，可减少长期应用外固定及卧床所致的并发症。     

经后路骨折间隙截骨治疗强直性脊柱炎胸腰椎应力骨折北大核心CSCD

目的探讨经后路骨折间隙截骨治疗强直性脊柱炎(ankylosing spondylitis,AS)胸腰椎应力骨折的有效性及安全性。方法2012年4月—2015年8月,采用经后路骨折间隙截骨并椎间植骨治疗AS胸腰椎应力骨折患者8例,其中男7例,女1例;年龄37～74岁,平均51岁。AS病史1～40年,平均21.7年。胸背部应力骨折病程2～60个月,平均18.5个月。病变节段:T_(8、9)1例,T_(10、11)2例,T_(11)2例,T_(12)、L_11例,L_(1、2)1例,L_(2、3)1例。术前神经功能根据Frankel分级为D级3例,E级5例。收集患者手术前后X线片、三维CT及MRI等影像学资料,测量全脊柱最大后凸角(global kyphosis,GK)、局部后凸角(local kyphosis,LK)、固定节段角度(angle of the fusion levels,AFL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)及矢状面平衡(sagittal vertical axis,SVA);采用疼痛视觉模拟评分(VAS)评价胸背部疼痛改善情况。结果手术时间210～320 min,平均267 min;术中出血量400～2 000 m L,平均963 m L。3例患者出现脑脊液漏,于术后5～7 d拔除引流管并缝合引流管口后切口逐步愈合;其余患者切口均Ⅰ期愈合。1例出现下肢麻木症状,术后给予口服甲钴胺1个月后恢复。8例患者均获随访,随访时间20～43个月,平均28.4个月。均未发生内固定物松动、断裂等并发症。所有患者骨折均愈合,愈合时间3～12个月,平均6.8个月。术后3个月,3例脊髓损伤患者Frankel分级由术前D级恢复至E级。所有患者术后1周及末次随访时GK、LK、AFL、PI、PT、SVA及VAS评分均较术前显著改善,差异有统计学意义(P<0.05);除末次随访时VAS评分显著低于术后1周(P<0.05)外,其余指标术后1周及末次随访间比较差异均无统计学意义(P>0.05)。结论经后路骨折间隙截骨能有效改善后凸畸形,纠正矢状面平衡,缓解胸背部疼痛并促进骨性愈合,是治疗AS胸腰椎应力骨折安全有效的方法。     

Fractures of the thoracic and lumbar spine in ankylosing spondylitis

Summary In the literature a total of 27 cases of thoracic and lumbar fractures in ankylosing Spondylitis have previously been reported in contrast to cervical fractures which are more common. Transvertebral fractures are relatively rare amounting to 8 cases. The majority of the fractures were transdiscal. Here three additional cases with four fractures are reported. Of these fractures two were transvertebral and two transdiscal. All reported fractures are reviewed regarding age, sex, trauma, fracture localization and type, neurologic complications and fracture healing. Compared to cervical fractures there are less neurological complications in thoracic and lumbar fractures (23%) in ankylosing spondylitis. These fractures mostly heal by moderate immobilisation. Attention should be paid to the possibility of fracture in ankylosing spondylitis even after minor trauma.

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Zusammenfassung In der Literatur sind bisher im ganzen 27 Fälle mit thorakalen oder lumbaren Frakturen bei Spondylitis Ankylopoetica rapportiert worden. Cervikale Frakturen sind dagegen weitaus gewöhnlicher. Transvertebrale Frakturen kommen verhältnismäßig selten vor (8 Fälle). Die Mehrzahl der Frakturen waren transdiskal. Hier werden drei neue Fälle mit vier Frakturen rapportiert. Von diesen Frakturen sind zwei transvertebral und zwei transdiskal. Alle rapportierten Frakturen sind mit Hinsicht auf Alter und Geschlechtszugehörigkeit des Patienten, Trauma, Lokalisation und Typ der Fraktur, neurologische Komplikationen und Frakturheilung rapportiert worden.Verglichen mit cervikalen Frakturen kommen bei Spondylitis Ankylopoetica weniger neurologische Komplikationen bei thorakalen und lumbaren Frakturen vor (23%). Diese Frakturen heilen meistens nach einer kürzeren Immobilisierung. Die Möglichkeit einer Fraktur bei Spondylitis Ankylopoetica sollte auch bei kleineren Schäden beachtet werden.

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This work was supported by the Swedish Medical Research Council (Project 17X-2031)     

Postsurgical recurrent stress fracture in the spine affected by ankylosing spondylitis

Stress fracture in the dorsolumbar region is a well-known complication of the rigid spine usually occurring at the end stages of ankylosing spondylitis. When indicated, surgical treatment by anterior spinal fusion is prescribed. Three cases illustrating the appearance of new stress fractures in different parts of the spine after the successful anterior surgical fusion of a previous lesion indicate the possibility of recurrence. This explains the persistence of back pain postoperatively. These stress fractures seem unrelated to spinal deformities. External bracing is useful, but additional surgical fusions may become necessary.     

Odontoid fracture complicating ankylosing spondylitis

Patients with ankylosing spondylitis are prone to fractures. We describe a 32-year-old male patient with an odontoid fracture and anterior dislocation of C1 vertebra relative to C2 complicating ankylosing spondylitis. The importance and difficulties of the rehabilitation program are stressed. The role of magnetic resonance imaging and three-dimensional computerized tomography in diagnosis is emphasized.     

胸椎骨折39例治疗分析

目的探讨胸椎骨折的损伤特点及治疗。方法对39例胸椎骨折患者的临床资料作回顾性分析。稳定压缩骨折10例单纯保守治疗,不稳定压缩骨折15例行后路减压植骨融合加椎弓根螺钉内固定,爆裂骨折10例行前路减压植骨融合Z-plate前路钢板内固定;骨折脱位3例及爆裂脱位1例采用前后联合入路。结果全部病例均获随访,时间6~24个月,平均12个月。神经功能明显改善,术后6个月植骨融合率达100%,未见内植物松动及断裂现象。结论胸椎骨折的治疗应根据骨折的类型及稳定性,对于不稳定骨折应行融合及内固定手术,合并有不完全性脊髓损伤者还应同时行减压手术。     

Radiographic measurement reliability of lumbar lordosis in ankylosing spondylitis

Introduction

Intraobserver and interobserver reliabilities of the several different methods to measure lumbar lordosis have been reported. However, it has not been studied sofar in patients with ankylosing spondylitis (AS).

Materials and methods

We evaluated the inter and intraobserver reliabilities of six specific measures of global lumbar lordosis in patients with AS. Ninety-one consecutive patients with AS who met the most recently modified New York criteria were enrolled and underwent anteroposterior and lateral radiographs of whole spine. The radiographs were divided into non-ankylosis (no bony bridge in the lumbar spine), incomplete ankylosis (lumbar spines were partially connected by bony bridge) and complete ankylosis groups to evaluate the reliability of the Cobb L1–S1, Cobb L1–L5, centroid, posterior tangent L1–S1, posterior tangent L1–L5, and TRALL methods.

Results

The radiographs were composed of 39 non-ankylosis, 27 incomplete ankylosis and 25 complete ankylosis. Intra- and inter-class correlation coefficients (ICCs) of all six methods were generally high. The ICCs were all ≥0.77 (excellent) for the six radiographic methods in the combined group. However, a comparison of the ICCs, 95 % confidence intervals and mean absolute difference (MAD) between groups with varying degrees of ankylosis showed that the reliability of the lordosis measurements decreased in proportion to the severity of ankylosis. The Cobb L1–S1, Cobb L1–L5 and posterior tangent L1–S1 method demonstrated higher ICCs for both inter and intraobserver comparisons and the other methods showed lower ICCs in all groups. The intraobserver MAD was similar in the Cobb L1–S1 and Cobb L1–L5 (2.7°–4.3°), but the other methods showed higher intraobserver MAD. Interobserver MAD of Cobb L1–L5 only showed low in all group.

Conclusion

These results are the first to provide a reliability analysis of different global lumbar lordosis measurement methods in AS. The findings in this study demonstrated that the Cobb L1–L5 method is reliable for measuring the global lumbar lordosis in AS.     

Axis fracture in ankylosing spondylitis: case report

Ankylosing spondylitis is a chronic inflammatory disease that results in the slow progressive transformation of the normal spine into a rigid and brittle tube containing the normal neural elements. This pathological condition predisposes the patient to fractures of this structure and a potential for neurological damage greater than that of the normal population. We present a spontaneous fracture of the C1-C2 complex through the base of the dens, with impending neurological deficits in such a patient. We have reviewed the pertinent literature and emphasized several points relative to the management of similar patients.